Frailty screening and a frailty pathway decrease length of stay, loss of independence, and 30-day readmission rates in frail geriatric trauma and emergency general surgery patients

Kathryn E. Engelhardt, Quentin Reuter, Jessica Liu, Jonathan F. Bean, Joliette Barnum, Michael B Shapiro, Allison Ambre, Amanda Dunbar, Mara Markzon, Tara Nandini Reddy, Christine Schilling, Joseph Anthony Posluszny*

*Corresponding author for this work

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

BACKGROUND Frail geriatric trauma and emergency general surgery (TEGS) patients have longer lengths of stay (LOS), more readmissions, and higher rates of postdischarge institutionalization than their nonfrail counterparts. Despite calls to action by national trauma coalitions, there are few published reports of prospective interventions. The objective of this quality improvement project was to first develop a frailty screening program, and, then, if frail, implement a novel frailty pathway to reduce LOS, 30-day readmissions, and loss of independence. METHODS This was a before-after study of a prospective cohort of all geriatric (≥65-years-old) patients admitted to the TEGS service from October 2016 to October 2017. All patients were screened for frailty for 3 months (preintervention) to obtain baseline outcomes. Subsequently, frail patients were entered into our frailty pathway (postintervention). Nonparametric statistical tests were used to assess significant differences in continuous variables; χ 2 and Fisher exact tests were used for categorical variables, where appropriate. Both process and outcome measures were evaluated. RESULTS Of 239 geriatric TEGS patients screened, 70 (29.3%) were frail. All TEGS geriatric patients were screened within 24 hours of admission. Following frailty pathway implementation, median LOS for frail patients decreased from 9 to 6 days (p = 0.4), readmissions decreased from 36.4% to 10.2% (p = 0.04), and loss of independence decreased by 40%, (100% vs 60%; p = 0.01). Outcomes for nonfrail geriatric patients did not differ between cohorts. CONCLUSIONS Screening for frailty followed by implementing a frailty pathway decreased LOS, loss of independence, and 30-day readmission rates for frail geriatric TEGS patients at a single urban academic institution. The pathway required no additional resources; rather, we shifted focus toward frail patients without negatively affecting outcomes in nonfrail geriatric TEGS patients. Implementation of this pathway with larger patient cohorts and in varied settings is needed to confirm a causal relationship between our intervention and improved outcomes. LEVEL OF EVIDENCE Therapeutic study, level IV.

Original languageEnglish (US)
Pages (from-to)167-173
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume85
Issue number1
DOIs
StatePublished - Jul 1 2018

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Geriatrics
Length of Stay
Emergencies
Wounds and Injuries
Institutionalization
Process Assessment (Health Care)
Quality Improvement
Outcome Assessment (Health Care)
Prospective Studies

Keywords

  • Geriatric
  • frailty
  • quality improvement

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Engelhardt, Kathryn E. ; Reuter, Quentin ; Liu, Jessica ; Bean, Jonathan F. ; Barnum, Joliette ; Shapiro, Michael B ; Ambre, Allison ; Dunbar, Amanda ; Markzon, Mara ; Reddy, Tara Nandini ; Schilling, Christine ; Posluszny, Joseph Anthony. / Frailty screening and a frailty pathway decrease length of stay, loss of independence, and 30-day readmission rates in frail geriatric trauma and emergency general surgery patients. In: Journal of Trauma and Acute Care Surgery. 2018 ; Vol. 85, No. 1. pp. 167-173.
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abstract = "BACKGROUND Frail geriatric trauma and emergency general surgery (TEGS) patients have longer lengths of stay (LOS), more readmissions, and higher rates of postdischarge institutionalization than their nonfrail counterparts. Despite calls to action by national trauma coalitions, there are few published reports of prospective interventions. The objective of this quality improvement project was to first develop a frailty screening program, and, then, if frail, implement a novel frailty pathway to reduce LOS, 30-day readmissions, and loss of independence. METHODS This was a before-after study of a prospective cohort of all geriatric (≥65-years-old) patients admitted to the TEGS service from October 2016 to October 2017. All patients were screened for frailty for 3 months (preintervention) to obtain baseline outcomes. Subsequently, frail patients were entered into our frailty pathway (postintervention). Nonparametric statistical tests were used to assess significant differences in continuous variables; χ 2 and Fisher exact tests were used for categorical variables, where appropriate. Both process and outcome measures were evaluated. RESULTS Of 239 geriatric TEGS patients screened, 70 (29.3{\%}) were frail. All TEGS geriatric patients were screened within 24 hours of admission. Following frailty pathway implementation, median LOS for frail patients decreased from 9 to 6 days (p = 0.4), readmissions decreased from 36.4{\%} to 10.2{\%} (p = 0.04), and loss of independence decreased by 40{\%}, (100{\%} vs 60{\%}; p = 0.01). Outcomes for nonfrail geriatric patients did not differ between cohorts. CONCLUSIONS Screening for frailty followed by implementing a frailty pathway decreased LOS, loss of independence, and 30-day readmission rates for frail geriatric TEGS patients at a single urban academic institution. The pathway required no additional resources; rather, we shifted focus toward frail patients without negatively affecting outcomes in nonfrail geriatric TEGS patients. Implementation of this pathway with larger patient cohorts and in varied settings is needed to confirm a causal relationship between our intervention and improved outcomes. LEVEL OF EVIDENCE Therapeutic study, level IV.",
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Frailty screening and a frailty pathway decrease length of stay, loss of independence, and 30-day readmission rates in frail geriatric trauma and emergency general surgery patients. / Engelhardt, Kathryn E.; Reuter, Quentin; Liu, Jessica; Bean, Jonathan F.; Barnum, Joliette; Shapiro, Michael B; Ambre, Allison; Dunbar, Amanda; Markzon, Mara; Reddy, Tara Nandini; Schilling, Christine; Posluszny, Joseph Anthony.

In: Journal of Trauma and Acute Care Surgery, Vol. 85, No. 1, 01.07.2018, p. 167-173.

Research output: Contribution to journalArticle

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T1 - Frailty screening and a frailty pathway decrease length of stay, loss of independence, and 30-day readmission rates in frail geriatric trauma and emergency general surgery patients

AU - Engelhardt, Kathryn E.

AU - Reuter, Quentin

AU - Liu, Jessica

AU - Bean, Jonathan F.

AU - Barnum, Joliette

AU - Shapiro, Michael B

AU - Ambre, Allison

AU - Dunbar, Amanda

AU - Markzon, Mara

AU - Reddy, Tara Nandini

AU - Schilling, Christine

AU - Posluszny, Joseph Anthony

PY - 2018/7/1

Y1 - 2018/7/1

N2 - BACKGROUND Frail geriatric trauma and emergency general surgery (TEGS) patients have longer lengths of stay (LOS), more readmissions, and higher rates of postdischarge institutionalization than their nonfrail counterparts. Despite calls to action by national trauma coalitions, there are few published reports of prospective interventions. The objective of this quality improvement project was to first develop a frailty screening program, and, then, if frail, implement a novel frailty pathway to reduce LOS, 30-day readmissions, and loss of independence. METHODS This was a before-after study of a prospective cohort of all geriatric (≥65-years-old) patients admitted to the TEGS service from October 2016 to October 2017. All patients were screened for frailty for 3 months (preintervention) to obtain baseline outcomes. Subsequently, frail patients were entered into our frailty pathway (postintervention). Nonparametric statistical tests were used to assess significant differences in continuous variables; χ 2 and Fisher exact tests were used for categorical variables, where appropriate. Both process and outcome measures were evaluated. RESULTS Of 239 geriatric TEGS patients screened, 70 (29.3%) were frail. All TEGS geriatric patients were screened within 24 hours of admission. Following frailty pathway implementation, median LOS for frail patients decreased from 9 to 6 days (p = 0.4), readmissions decreased from 36.4% to 10.2% (p = 0.04), and loss of independence decreased by 40%, (100% vs 60%; p = 0.01). Outcomes for nonfrail geriatric patients did not differ between cohorts. CONCLUSIONS Screening for frailty followed by implementing a frailty pathway decreased LOS, loss of independence, and 30-day readmission rates for frail geriatric TEGS patients at a single urban academic institution. The pathway required no additional resources; rather, we shifted focus toward frail patients without negatively affecting outcomes in nonfrail geriatric TEGS patients. Implementation of this pathway with larger patient cohorts and in varied settings is needed to confirm a causal relationship between our intervention and improved outcomes. LEVEL OF EVIDENCE Therapeutic study, level IV.

AB - BACKGROUND Frail geriatric trauma and emergency general surgery (TEGS) patients have longer lengths of stay (LOS), more readmissions, and higher rates of postdischarge institutionalization than their nonfrail counterparts. Despite calls to action by national trauma coalitions, there are few published reports of prospective interventions. The objective of this quality improvement project was to first develop a frailty screening program, and, then, if frail, implement a novel frailty pathway to reduce LOS, 30-day readmissions, and loss of independence. METHODS This was a before-after study of a prospective cohort of all geriatric (≥65-years-old) patients admitted to the TEGS service from October 2016 to October 2017. All patients were screened for frailty for 3 months (preintervention) to obtain baseline outcomes. Subsequently, frail patients were entered into our frailty pathway (postintervention). Nonparametric statistical tests were used to assess significant differences in continuous variables; χ 2 and Fisher exact tests were used for categorical variables, where appropriate. Both process and outcome measures were evaluated. RESULTS Of 239 geriatric TEGS patients screened, 70 (29.3%) were frail. All TEGS geriatric patients were screened within 24 hours of admission. Following frailty pathway implementation, median LOS for frail patients decreased from 9 to 6 days (p = 0.4), readmissions decreased from 36.4% to 10.2% (p = 0.04), and loss of independence decreased by 40%, (100% vs 60%; p = 0.01). Outcomes for nonfrail geriatric patients did not differ between cohorts. CONCLUSIONS Screening for frailty followed by implementing a frailty pathway decreased LOS, loss of independence, and 30-day readmission rates for frail geriatric TEGS patients at a single urban academic institution. The pathway required no additional resources; rather, we shifted focus toward frail patients without negatively affecting outcomes in nonfrail geriatric TEGS patients. Implementation of this pathway with larger patient cohorts and in varied settings is needed to confirm a causal relationship between our intervention and improved outcomes. LEVEL OF EVIDENCE Therapeutic study, level IV.

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